The publication of the Francis report on the scandal at Mid-Staffs has prompted a grown-up debate with both the coalition and Labour giving considered responses. Both parties rightly promised to avoid a river of new regulations but key differences in approach nevertheless emerged.
The report, it must be said, offers some devastating verdicts on past policy. It identifies systemic failings and not just a badly run hospital. While there was a grip on NHS money, there was no such control over quality. And past efforts at patient and public engagement failed.
The NHS has been working hard to remedy these failings since Francis published his first report. Yet there is clearly much more to do to make sure there are no repeats of the scandal at a time of structural change and increasing financial pressures.
Jeremy Hunt offered a remedy of transparency, inspection and a bonfire of bureaucracy. All have parts to play. The new ‘friends and family test’ – while controversial in the service – is an approach used effectively by charities and companies and will drive up standards. A new risk-based inspection regime was also clearly needed but should not stop at the doors of the hospital but be extended to community care.
The assault on bureaucracy will need to be watched. It will be led by a respected NHS manager with a vision to look at care with ‘transformational not transactional’ eyes. Yet previous experiences of reviews of red tape suggest that valuable regulations can be lost if care is not taken.
What was missing from the Francis report and the coalition’s response to it was any sense of empowering patients. Despite the rhetoric of putting the patient at the centre, theirs were strategies for professionals not patients.
This is a gap Labour has sought to fill. At a Reform conference yesterday, Liz Kendall argued that patients, carers and families must be put in the driving seat of change. Regulators can’t be everywhere, she pointed out, while patients and families are. Real-time feedback on NHS quality is coming into place. But it needs more clout in decision-making to have an effect on quality.
The biggest visible difference between the parties is that Labour is opening up discussion on transformational change while Hunt is steering away from the issue. Labour’s questions on single budgets, merged health and social care and primary and secondary care too, are good ones but put the party at the forefront of some difficult and controversial issues. The Conservatives support such transformational change in principle but are finding the practice challenging and seem to be following a political strategy of reassurance after all the changes introduced in the Health and Social Care Act. Will this play out in public opinion?
For me, the best immediate response to Francis came from Mark Britnell, a former and likely future contender for NHS chief executive. He suggested that for the next two or three years NHS trusts should put their quality incentives (known as CQUINs) into understanding and improving patient experience. That can be done without legislation or structural change and would be an important step in improving quality across the system. Let’s see how GP commissioners and NHS trusts respond.
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Neil Churchill is the chief executive of Asthma UK and tweets @neilgchurchill. This article is written in a personal capacity
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